Beneficiary Advisory Panel Handout Uniform Formulary Decisions 6 Jan 2011
|
|
|
- Catherine Thompson
- 5 years ago
- Views:
Transcription
1 Beneficiary Advisory Panel Handout Uniform Formulary Decisions 6 Jan 2011 PURPOSE: The purpose of this handout is to provide BAP Committee members with a reference document for the relative clinical effectiveness presentations for each Uniform Formulary (UF) Class review 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 1 of 17
2 Table 1: Uniform Formulary Recommendations from the v 2010 DoD P&T Committee meeting for the n-insulin Anti-Diabetic Drugs n-insulin Anti-Diabetic Drugs Subclass UF recommendation Generic Drug Name (Brand) DPP-4 GLP-1 TZDs Biguanides Sulfonylureas AGI UF Class step applies See note 1 UF Class and subclass step apply see note 1,2 UF Class step applies See note 1 NF Class step applies See note 1 Step Preferred UF NF Step Preferred UF UF Sitagliptin (Januvia) Sitagliptin+met (Janumet) Saxagliptin (Onglyza) Exenatide (Byetta) Liraglutide (Victoza) Pioglitazone (Actos) Pioglitazone+met (Actoplus Met) Pioglitazone+met ER (Actoplus Met XR) Pioglitazone/glimepiride (Duetact) Rosiglitazone (Actos) Rosiglitazone/metformin (Avandamet) Rosiglitazone/glimepiride (Avandaryl) Metformin IR 500, 850, 1000 mg Riomet liq 500/5 Metformin ER 500, 750 mg Metformin ER (Fortamet ER) 500, 1000 mg Metformin ER (Glumetza) 500, 1000 mg Chlorpropamide Tolazamide Tolbutamide Glimepiride Glipizide Glipizide ER Glyburide Glyburide micronized Glipizide/met Glyburide/met Acarbose (Precose) Miglitol (Glyset) Generic Available Amylin Agonists UF Pramlintide (Symlin) Meglitinides UF Nateglinide Repaglinide +/- met (Prandin,Prandimet) tes: 1. Patient must have a documented trial or contraindication for metformin or a sulfonylurea prior to receiving a drug in this subclass. 2. Patient must have a documented trial or contraindication for Byetta prior to receiving Victoza Recommended implementation period 60 days 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 2 of 17
3 Figures 1: Anti-diabetic Subclass Utilization - 30 Day Equivalents at All POS Figure 2: Biguanide (Metformin) 30 Day Equivalents at All POS 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 3 of 17
4 Figure 3: Sulfonylureas 30 day Equivalents at All POS Figure 4: DPP-4 Utilization 30 Day Equivalents at All POS 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 4 of 17
5 Figure 5: GLP-1 Utilization -30 Day Equivalents at All POS Figure 6: TZD Utilization 30 Day Equivalents at All POS 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 5 of 17
6 Figure 7: Meglitinide 30 day Equivalents at All POS Figure 8: AGI 30 Day Equivalents at All POS 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 6 of 17
7 Figure 9: Amylin Agonists 30 day Equivalents at All POS 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 7 of 17
8 Table 2: Inhaled Corticosteroid/Long-Acting Beta Agonists Drug Class Generic Name (Brand) Formulations ICS/LABA combinations Generics Available? Uniform Formulary n-formulary Fluticasone/salmeterol (Advair ) Diskus DPI/HFA MDI Budesonide/Formoterol (Symbicort ) pmdi Mometasone/Formoterol (Dulera) HFA MDI ne Dulera was recommended for UF placement with Quantity Limits Recommended implementation period pmdi: pressurized metered dose inhaler DPI: dry powder inhaler HFA: hydrofluoroalkane 60 days Figure 10: Inhaled Corticosteroid/Long-Acting Beta Agonists Dulera (mometasone/formoterol inhaler) Grams dispensed 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 8 of 17
9 Table 3: Antilipidemic-1s Drug Class Generic Name (Brand) Formulations Antilipidemic 1s - Statins, Statin Combinations, Ezetimibe, & Niacin Generics Available? Statins Atorvastatin (Lipitor) tabs Fluvastatin (Lescol) tabs Fluvastatin ER (Lescol XL) tabs Lovastatin IR (Mevacor) tabs Lovastatin ER (Altoprev) tabs Pravastatin (Pravachol) tabs Simvastatin (Zocor) tabs Uniform Formulary Rosuvastatin (Crestor) tabs Statin Combinations Atorvastatin / amlodipine (Caduet) tabs Lovastatin / niacin ER (Advicor) tabs Simvastatin / niacin ER (Simcor) tabs Simvastatin/ ezetimibe (Vytorin) tabs Add-on therapies Ezetimibe (Zetia) tabs Niacin ER (Niaspan) tabs Niacin IR (Niacor) tabs n-formulary Pitavastatin (Livalo) tabs Pitavastatin was recommended to be made non-formulary Recommended implementation period 60 days Figure 11: Antilipidemic-1s Livalo (pitavastatin tablets) 30 day equivalents 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 9 of 17
10 Table 4: Newer Sedative Hypnotic Newer Sedative-Hypnotic Agents UF Status Generic Name (Brand) Formulations Generics Available? Zolpidem Immediate Release (Ambien) tab yes Uniform Formulary Eszopiclone (Lunesta) tab no Doxepin (Silenor) tab no Ramelteon (Rozerem) tab no n-formulary Zaleplon (Sonata) cap yes Zolpidem ER (Ambien CR) tab no Zolpidem (Edluar) sublingual no Silenor recommended to be Uniform Formulary Recommended implementation period 60 days for prior authorization on Silenor Figure 12: Newer Sedative Hypnotic Silenor (doxepin tablets) Qty dispensed 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 10 of 17
11 Table 5: Narcotic Analgesic Exalgo (hydromorphone extended release tablets) Uniform Formulary Recommendations from v 2010 for the Narcotic Analgesics Narcotic Analgesics UF Status Generic Name (Brand) Formulations Generics Available? High-potency single analgesic agents Long-acting agents (> 12 hour duration) Fentanyl transdermal system (Duragesic) patch Morphine sulfate ER 24 hr (Kadian, Avinza) cap Hydromorphone ER 24 hr (Exalgo ) ER tabs Morphine sulfate ER 12 hr (MS Contin, Oramorph) tab, soln, supp, inj Morphine sulfate ER/Naltrexone (Embeda) caps Oxycodone ER (Oxycontin) tabs Oxymorphone (Opana ER) tabs Short acting agents (<12 hour duration) Codeine tabs, soln, inj Fentanyl citrate buccal (Fentora) tabs Fentanyl citrate transmucosal (Actiq) lozenges Uniform Formulary Fentanyl citrate transmucosal soluble film (Onsolis) Soluble Film, except for Hydromorphone (Dilaudid) tab, inj, liquid 1 mg tab Levorphanol (Levo-Dromoran) tab, inj Meperidine (Demerol) tab, soln, inj Meperidine / promethazine (Mepergan Fortis) caps Methadone (Dolophine) tab, oral conc, soln, inj Morphine sulfate IR tabs Opium tincture Opium / belladonna alkaloids supp Oxycodone IR caps, oral conc, soln Oxymorphone IR (Opana) tabs High-potency combination agents Oxycodone /APAP (e.g., Percocet, Tylox, others) tab, cap, soln Oxycodone / ASA (Percodan) tabs Low potency single analgesic agents Buprenorphine (Buprenex) inj (excludes SL tabs) Butorphanol (Stadol) nasal spray, inj Pentazocine / naloxone (Talwin NX) tabs Propoxyphene (Darvon) caps, tabs Nalbuphine (Nubain ) not a controlled substance) Inj Tramadol IR(Ultram) not a controlled substance tab 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 11 of 17
12 Table 5: Narcotic Analgesic Exalgo (hydromorphone extended release tablets) Uniform Formulary Recommendations from v 2010 for the Narcotic Analgesics (continued) Uniform Formulary Low potency combination agents Codeine / APAP (Tylenol with codeine) tabs, elixir, oral susp Codeine / ASA tabs Codeine / ASA / carisoprodol (Soma) tabs Codeine / caffeine / butalbital / APAP (Fioricet with codeine) caps Codeine / caffeine / butalbital / ASA (Fiorinal with caffeine) caps, tabs Dihydrocodeine / caffeine / APAP e.g., Panlor DC, Panlor SS) caps, tabs Dihydrocodeine / caffeine / ASA (Synalgos-DC) caps Hydrocodone / APAP (e.g., Lortab, Lorcet, Vicodin, others) caps Pentazocine / APAP (Talacen) tabs Propoxyphene / APAP (Darvocet) tabs n-formulary Propoxyphene / ASA / caffeine (Darvon Compound 65) Tramadol/APAP (Ultracet) not a controlled substance Low potency single analgesic agents caps Tramadol ER (Ultram ER and Ryzolt) tab High potentcy single analgesic agents; short-acting agents (<12 hours duration) tab Tapentadol (Nucynta) tab Exalgo revommended to be Uniform Formulary Recommended Implementation Period t Applicable for Exalgo Figure 13: Narcotic Analgesic Exalgo (hydromorphone ER tablets) Total Qty Dispensed 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 12 of 17
13 Table 6: Antilipidemic-2s Antilipidemic II (LIP-2s) UF Status / Implementation Period Formulary n-formulary Generic Name (Brand) Formulations Generics Available? Fibric Acid Derivatives Fenofibrate meltdose (Fenoglide ) Tab Fenofibrate IDD-P (micronized) (Triglide) tab Fenofibrate micronized/nonmicronized (Lofibra) tab/cap Gemfibrozil (Lopid) tab Bile Acid Sequestrants (BAS) Cholestyramine (Questran, Questran Light) powder Colestipol (Colestid) tab Fibric Acid Derivatives Fenofibrate acid (Fibricor) caps Fenofibrate acid (Trilipix) caps Fenofibrate nanocrystallized (Tricor) tab Fenofibrate micronized (Antara) cap Omega-3 fatty acids Prescription omega-3 fatty acids (Omacor) cap Bile Acid Sequestrants (BAS) Colesevelam (Welchol) tab Fenofibrate acid (Fibricor) recommended to be Uniform Formulary Recommended implementation period 60 days for Fibricor Figure 14: Antilipidemic-2s Fibricor (fenofibric acid) 30 day Equivalents 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 13 of 17
14 Table 7: Contraceptives Contraceptives Uniform Formulary EE 20 mcg; 0.1 mg levonorgestrel EE 20 mcg; 1.0 mg norethindrone Monophasic OCs with 20 mcg EE EE 20 mcg; 1.0 mg norethindrone; ferrous fumarate EE 20 mcg; 3 mg drospirenone (Yaz) EE 30 mcg; 0.15 mg levonorgestrel (excluding Seasonale) EE 30 mcg; 0.3 mg norgestrel EE 30 mcg; 0.15 mg desogestrel Monophasic OCs with 30 mcg EE EE 30 mcg; 1.5 mg norethindrone EE 30 mcg; 1.5 mg norethindrone; ferrous fumarate EE 30 mcg; 3 mg drospirenone (Yasmin) EE 35 mcg; 0.5 mg norethindrone EE 35 mcg; 0.25 mg norgestimate Monophasic OCs with 35 mcg EE EE 35 mcg; 1.0 mg norethindrone EE 35 mcg; 1.0 mg ethynodiol diacetate Mestranol 50 mcg; 1 mg norethindrone Monophasic OCs with 50 mcg EE or EE 50 mcg; 1 mg ethynodiol diacetate mestranol EE 50 mcg; 0.5 mg norgestrel EE 35 mcg; 0.5/1.0 mg norethindrone Biphasic OCs EE 20/10 mcg; 0.15 mg desogestrel EE 25 mcg; 0.18/0.215/0.25 mg norgestimate (Ortho Tri-Cyclen Lo) EE 35 mcg; 0.18/0.215/0.25 mg norgestimate EE 30/40/30 mcg; 0.05/0.075/0.125 mg levonorgestrel Triphasic OCs EE 35 mcg; 0.5/1/0.5 mg norethindrone EE 35 mcg; 0.5/0.75/1 mg norethindrone EE 25 mcg; 0.1/0.125/0.15 mg desogestrel Progestogen-only OCs 0.35 mg norethindrone Patch EE; norelgestromin (Ortho-Evra) Vaginal ring EE; etonorgestrel (Nuvaring) 104 mg/ 0.65mL depot medroxyprogesterone acetate Injectable (Depo-subq Provera 104) 150 mg/ml depot medroxyprogesterone acetate Emergency contraceptives 0.75 mg levonorgestrel (Plan B) Estradiol valerate/dienogest (Natazia) n- Formulary EE 30 mcg; levonorgestrel 0.15 mg in special packaging for extended use (Seasonale) EE 35 mcg; 0.4 mg norethindrone (Ovcon 35) EE 50 mcg; 1 mg norethindrone (Ovcon 50) EE 20/30/35 mcg; norethindrone 1 mg (Estrostep Fe) Implementation 60 days Plan EE = ethinyl estradiol; OC = oral contraceptive. Natazia recommended for non formulary 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 14 of 17
15 Figure 15: Contraceptive Agents Natazia (estradiol valerate/dienogest) 30 day Equivalents 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 15 of 17
16 Table 7 Table of Implementation Status of UF Recommendations/Decisions Summary Table Meeting Drug Class n-formulary Medications Total Beneficiaries Affected (# of patients affected) Beneficiaries Affected by POS MTF Retail Mail Order Implementation Plan First Wednesday X days after the decision date Step Therapy v 2010 n-insulin Diabetes Drugs Biguanides Metformin ER 500, 1000 mg (Fortamet) Metformin ER 500, 1000 mg (Glumetza) 4, days no v 2010 n-insulin Diabetes Drugs Thiazolidinediones Rosiglitazone (Avandia) Rosiglitazone/ metformin (Avandamet) Rosiglitazone/ glimepiride (Avandaryl) 6698 (new users who will hit metformin/sulf step per quarter) 17,497 Rosi and combo patients 60 days Automated PA applies with metformin or a sulfonylurea preferred v 2010 n-insulin Diabetes Drugs DPP-4 Inhibitors ne 7844 (new users who will hit metformin/sulf step per quarter) 60 days Automated PA applies with metformin or a sulfonylurea preferred v 2010 n-insulin Diabetes Drugs GLP-1 Receptor Agonists ne 2229 (new users who will hit metformin/sulf step per quarter) of those 1962 Victoza users will hit Byetta preferred step 60 days Automated PA applies with metformin or a sulfonylurea preferred Automated PA applies with Byetta preferred v 2010 Antilipidemic Agents I Pitavastatin (Livalo) (v 2010) days Automated PA with generics or atorvastatin or atorvastatin as the preferred drugs v 2010 Antilipidemic Agents II Fenofibric acid (Fibricor) (v 2010) days ne 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 16 of 17
17 Meeting Drug Class n-formulary Medications Total Beneficiaries Affected (# of patients affected) Beneficiaries Affected by POS MTF Retail Mail Order Implementation Plan First Wednesday X days after the decision date Step Therapy v 2010 Contraceptive Agents Estradiol valerate/dienogest (Natazia) (v 2010) See TRICARE formulary search tool* for remainder of NF drugs days ne v 2010 Newer Insomnia ne 230 (new users hit step in the first month of use) 60 days Automated PA applies with zolpidem IR preferred 6 Jan 2011 Beneficiary Advisory Panel Meeting Page 17 of 17
Beneficiary Advisory Panel Handout Uniform Formulary Decisions 24 June 2010
Beneficiary Advisory Panel Handout Uniform Formulary Decisions 24 June 2010 PURPOSE: The purpose of this handout is to provide BAP Committee members with a reference document for the relative clinical
Beneficiary Advisory Panel Handout Uniform Formulary Decisions 23 June 2011
Beneficiary Advisory Panel Handout Uniform Formulary Decisions 23 June 211 PURPOSE: The purpose of this handout is to provide BAP Committee members with a reference document for the relative clinical effectiveness
UF Decision Report FY06-07 Beneficiary Advisory Panel 10 Jan 2008
UF Decision Report FY06-07 Beneficiary Advisory Panel 10 Jan 2008 Promoting high quality, cost effective drug therapy throughout the Military Health System UF Decisions, May 07 Class FY05 rank, total $
TRICARE Uniform Formulary. Pre-Authorization Requirements
TRICARE Uniform Formulary Pre-Authorization Requirements The Department of Defense (DoD) requires pre-authorization on select medications. These medications are on the DoD s pre-authorization list because
Xyrem (Sodium Oxybate)
Texas Prior Authorization Program Clinical Criteria Drug/Drug Class Clinical Criteria Information Included in this Document Drugs requiring prior authorization: the list of drugs requiring prior authorization
Beneficiary Advisory Panel Handout Uniform Formulary Decisions 25 March 2010
Beneficiary Advisory Panel Handout Uniform Formulary Decisions 25 March 2010 PURPOSE: The purpose of this handout is to provide BAP Committee members with a reference document for the relative clinical
Texas Prior Authorization Program Clinical Edit Criteria
Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Clinical Edit Information Included in this Document Drugs requiring prior authorization: the list of drugs requiring prior authorization
Cigna Drug and Biologic Coverage Policy
Cigna Drug and Biologic Coverage Policy Subject Controlled Substance Analgesic and Narcotic Antagonist Quantity Limitations Table of Contents Coverage Policy... 1 General Background... 6 Coding/Billing
Uniform Formulary Decisions 9 January 2014
Beneficiary Advisory Panel Handout Uniform Formulary Decisions 9 January 2014 Purpose: The purpose of this handout is to provide the BAP members with a reference document for the clinical effective presentation
Capital BlueCross Open/Closed Formulary Update (1 st Quarter 2017)
Capital BlueCross Open/Closed Formulary Update (1 st Quarter 2017) The Capital BlueCross formulary is a reference list of prescription drugs that contains a wide range of generic and brand drugs that have
Opiate/Benzodiazepine/Muscle Relaxant Combinations
Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Opiate/Benzodiazepine/Muscle Relaxant Combinations Clinical Edit Information Included in this Document Drugs requiring prior authorization:
APPROVED PA CRITERIA. Initial Approval: January 10, 2018 Revised Dates: April 11, 2018 CRITERIA FOR PRIOR AUTHORIZATION
Initial Approval: January 10, 2018 Revised Dates: April 11, 2018 CRITERIA FOR PRIOR AUTHORIZATION PROVIDER GROUP Pharmacy Opioid Products Indicated for Pain Management MANUAL GUIDELINES All dosage forms
New Hampshire Healthy Families CLINICAL POLICY
New Hampshire Healthy Families CLINICAL POLICY DEPARTMENT: Pharmacy DOCUMENT NAME: Opioid Analgesics PAGE: 1 o f 6 REFERENCE NUMBER: NH.PPA.13 EFFECTIVE DATE: 6/1/2016 REPLACES DOCUMENT: N/A RETIRED: REVIEWED:
MTF Quarterly Webcast March 8, LTC Stacia Spridgen Director, DoD Pharmacoeconomic Center
MTF Quarterly Webcast March 8, 2011 LTC Stacia Spridgen Director, DoD Pharmacoeconomic Center Greetings from the PEC Purpose of the Quarterly MTF Webcast DCO Ground Rules Type questions into the DCO system
Pequot Health Care Opioid Analgesic Quantity Program*
Pequot Health Care 1 Annie George Drive Mashantucket, CT 06338 Phone: 1-888-779-6638 Fax: 1-860-396-6494 Pequot Health Care Opioid Analgesic Quantity Program* Effective January 2018 *Quantity Program limits
Connecticut Medicaid P&T Meeting Minutes June 5, 2008
Connecticut Medicaid P&T Meeting Minutes June 5, 2008 The meeting started at 6:30 pm Attendance Present Members: Carl Sherter, MD Kenneth Marcus, MD Lester Silberman, MD Peggy Manning Memoli, Pharm D Richard
DEPARTMENT OF DEFENSE PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS. November 2010
DEPARTMENT OF DEFENSE PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS I. CONVENING November The Department of Defense (DoD) Pharmacy and Therapeutics (P&T) Committee convened at 0800 hours on November
Cholesterol. Medicines To Help You
Medicines To Help You Cholesterol Use this guide to help you talk to your doctor, pharmacist, or nurse about your cholesterol medicines. The guide lists all of the FDA-approved products now available to
Opioid Management Program October 2018
Opioid Management Program October 2018 What Is the Opioid Management Program? This program is based on guidelines developed by the U.S. Centers for Disease Control and Prevention (CDC). It consists of
Opioid Management Program May 2018
Opioid Management Program May 2018 What Is the Opioid Management Program? This program is based on guidelines developed by the U.S. Centers for Disease Control and Prevention (CDC). It consists of daily
Opioid Analgesic/Opioid Combination Products
Market DC Opioid Analgesic/Opioid Combination Products Override(s) Quantity Limit Approval Duration 1 year Generic Name Brand Name Quantity Limit APAP/Caf/Dihydrocodeine 320.5mg/30mg/16mg APAP/Caf/Dihydrocodeine
Beneficiary Advisory Panel Handout Uniform Formulary Decisions June 2006
Beneficiary Advisory Panel Handout Uniform Formulary Decisions June 2006 PURPOSE: The purpose of this handout is to provide BAP Committee members with a reference document for the relative clinical-effectiveness
Pharmacy Medical Necessity Guidelines: Opioid Analgesics
Pharmacy Medical Necessity Guidelines: Effective: January 1, 2019 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy (RX) or Medical (MED) Benefit
Generic Label Name Drug Strength Dosage Form Example Product (s) MME/Unit ACETAMINOPHEN WITH CODEINE
STATE OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION DIVISION OF HEALTH CARE FINANCE AND ADMINISTRATION BUREAU OF TENNCARE 3 Great Circle Road NASHVILLE, TENNESSEE 37243 This notice is to advise
Non-Insulin Diabetes Medications Summary
Non-Insulin Diabetes Medications Summary Medications marked with an asterisk (*) can cause hypoglycemia INSULIN SECRETAGOGUES Sulfonylureas* GLYBURIDE* (Diabeta) (Micronase) production. Side effects: Potential
ARBS MEDICATION(S) SUBJECT TO STEP THERAPY DIOVAN HCT MG TAB, DIOVAN HCT MG TABLET
ARBS DIOVAN HCT 160-12.5 MG TAB, DIOVAN HCT 80-12.5 MG TABLET 30-day trial of a Step 1 drug in the previous 120 days is required. Step 1 Drugs: Losartan, Losartan/HCTZ PAGE 1 LAST UPDATED 05/2016 BILE
GHC-SCW Mandated Coverage Alphabetical Index Last Updated 8/1/2018
Search Tip: This is a large document, but you can search quickly and easily by clicking on the binocular icon on your toolbar. It will then display a search box for you to type in the name of the drug
PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select Formulary October 1, 2018 Updates. Formulary. Alternatives
PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select October 1, 2018 Updates Drug Name efavirenz 600mg (Brand = Sustiva ) trientine (Brand = Syprine ) hydrocortisone lot 0.1% (Brand = Locoid ) sumatriptan-naproxen
Opioid Analgesic/Opioid Combination Products
Opioid Analgesic/Opioid Combination Products Override(s) Quantity Limit Approval Duration 1 year Generic Name Brand Name Quantity Limit 320.5mg/30mg/16mg 356.4mg/30mg/16mg 325mg/30mg/16mg Trezix (new formulation)
MEDICARE Program Policies & Procedures POLICY NUMBER: Medicare D-111
POLICY: Medicare Part D Formulary-Level Cumulative Opioid and Opioid/Buprenorphine POS Edits MEDICARE Program Policies & Procedures POLICY NUMBER: Medicare D-111 Policy for contracts H3351, S3521 and H3335
Section 2 Class III, IV & V Pharmaceuticals Page 13
Section 2 Class III, IV & V Pharmaceuticals Page 13 ACETAMINOPHEN W/ CODEINE #3 30MG TABS (GENERIC TYLENOL) #100 41.99 ACETAMINOPHEN W/ CODEINE #3 30MG TABS #1000 298.99 ACETAMINOPHEN W/ CODEINE #4 60MG
Victoza (Liraglutide) Solution for Injection
Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Clinical Edit Information Included in this Document Drugs requiring prior authorization: the list of drugs requiring prior authorization
II. UF CLASS REVIEWS SHORT-ACTING BETA AGONISTS (SABAs)
DEPARTMENT OF DEFENSE PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS INFORMATION FOR THE UNIFORM FORMULARY BENEFICIARY ADVISORY PANEL I. UNIFORM FORMULARY REVIEW PROCESS Under 10 United States Code
High ( 50%) Restrictions mg 20-40mg PA; TS ⱡ 15 ⱡ
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Cholesterol P&T DATE: 5/9/2017 THERAPEUTIC CLASS: Cardiovascular REVIEW HISTORY: 5/16, 5/15, 2/14, 5/12, LOB AFFECTED: Medi-Cal
Generics. Lead with. Prescription Step Therapy Program
Lead with Generics Prescription Step Therapy Program WWW.BCBSLA.COM 04HQ3972 R11/10 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company GENERIC DRUGS: A
DOD PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS INFORMATION FOR THE UNIFORM FORMULARY BENEFICIARY ADVISORY PANEL
DOD PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS INFORMATION FOR THE UNIFORM FORMULARY BENEFICIARY ADVISORY PANEL I. UNIFORM FORMULARY REVIEW PROCESS Under 10 United States Code 1074g, as implemented
New Measure Recommended for Endorsement by PQA
New Measure Recommended for Endorsement by PQA Measure: Statin Use in Persons with Diabetes Description: The percentage of patients ages 40 75 years who were dispensed a medication for diabetes that receive
CRITERIA Trial of two generic formulary products from the following: atomoxetine or ADHD stimulant medication.
ADHD STIMULANTS ATOMOXETINE HCL, DEXEDRINE 10 MG TABLET, DEXEDRINE 5 MG TABLET, DEXMETHYLPHENIDATE HCL, DEXMETHYLPHENIDATE HCL ER, DEXTROAMPHETAMINE 10 MG TAB, DEXTROAMPHETAMINE 5 MG TAB, DEXTROAMPHETAMINE
Prior Authorization for Opioid Products Indicated for Pain Management
Kansas Medical Assistance Program PA Phone 800-933-6593 PA Fax 800-913-2229 Amerigroup PA Pharmacy Phone 855-201-7170 PA Pharmacy Fax 800-601-4829 Sunflower PA Pharmacy Phone 877-397-9526 PA Pharmacy Fax
Connecticut Medicaid P&T Meeting Minutes June 4, 2009
Connecticut Medicaid P&T Meeting Minutes June 4, 2009 The meeting started at 6:30 pm Attendance Present Members: Carl Sherter, MD Eric Einstein, MD Lester Silberman, MD Charles Thompson, MD Peggy Manning
CNS DEPRESSANT OVERDOSE
Signs and symptoms of CNS depressant overdose include: altered mental status, respiratory depression, hypotension, bradycardia, pulmonary edema, coma, and constricted pupils (opioids only). The following
Bree Collaborative AMDG Opioid Prescribing Guidelines Workgroup. Opioid Prescribing Metrics - DRAFT
Bree Collaborative AMDG Opioid Prescribing Guidelines Workgroup Opioid Prescribing Metrics - DRAFT Definitions: Days Supply: The total of all opioid prescriptions dispensed during the calendar quarter
Secretary for Health and Family Services Selections for Preferred Products
Secretary for Health and Family Services Selections for Preferred Products This is a summary of the final Preferred Drug List (PDL) selections made by the Secretary for Health and Family Services based
Medical Policy An independent licensee of the Blue Cross Blue Shield Association
Opioid Immediate Release Page 1 of 13 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Opioid Immediate Release Prime Therapeutics will review Prior Authorization
Diabetes Medication Updates Erica Bukovich, PharmD, BC-ADM, CDE September 20, 2018
Diabetes Medication Updates Erica Bukovich, PharmD, BC-ADM, CDE September 20, 2018 Learning Objectives Identify medication classes available for treatment of individuals with diabetes. Demonstrate understanding
Type II Diabetes Improving Blood Sugar Control. Geneva Clark Briggs, Pharm.D., BCPS
Type II Diabetes Improving Blood Sugar Control Geneva Clark Briggs, Pharm.D., BCPS Overview Importance of glucose control State of control Review available therapies Helping patients achieve control The
1/29/2013. Schedule II Controlled Substances: Basics and Beyond. Controlled Substances. Controlled Substances, Schedule I
chedule II Controlled ubstances: Basics and Beyond James L. Besier, Ph.D., R.Ph., FAHP Adjunct Associate Professor College of Nursing Adjunct Assistant Professor James L. Winkle College of Pharmacy University
RPCC Pharmacy Forum. The Type 2 Diabetes Issue. Type 2 Diabetes: The Basics
Nov/Dec 2015 Issue 11 RPCC Pharmacy Forum Special Interest Articles: Diabetes Medication Chart Insulin Chart Afreeza Did you know? Exanatide, marketed as Byetta, is the synthetic form of exendin-4, which
STEP THERAPY ALGORITHMS PUP Select Formulary
The Step Therapy drug will be dispensed if the drug has been dispensed within 120 days of current fill or if alternative (Step 1) drugs have been used first. If the member s prescription claim fails the
DEPARTMENT OF DEFENSE PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS INTERIM MEETING
DEPARTMENT OF DEFENSE PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS INTERIM MEETING Addendum December 17, 2013 I. UNIFORM FORMULARY (UF) DRUG CLASS REVIEWS A. Anti-Lipidemic-ls (LIP-ls) Background-New
Beneficiary Advisory Panel Handout Uniform Formulary Decisions 14 Jan 2010
Beneficiary Advisory Panel Handout Uniform Formulary Decisions 14 Jan 21 PURPOSE: The purpose of this handout is to provide BAP Committee members with a reference document for the relative clinical effectiveness
Save on your drugs with HealthyRx
Save on your drugs with HealthyRx HealthyRx is a savings program offered through the UVa Hoo s Well program. It helps lower your costs on drugs for certain health conditions. Effective 4/1/17, you are
10 mg hydrocodone equals how much oxycodone
Cari untuk: Cari Cari 10 mg hydrocodone equals how much oxycodone Posts about dilaudid 8 vs oxycodone 30 written by buyprescriptionmedication. Can you help me with the conversion of Oxycodone IR (5mg tab)
Oral and Injectable Medication Options for Diabetes Treatment
Oral and Injectable Medication Options for Diabetes Treatment Presented by: Dr. Daphne E. Smith, Pharm.D., CDE Clinical Assistant Professor/Clinical Pharmacist-University of Illinois at Chicago College
Diabetes Medications: Oral Anti-Hyperglycemic Medications
Diabetes Medications: Oral Anti-Hyperglycemic Medications Medication Types 1. Biguanides 2. Sulfonylureas 3. Thiazolidinediones (TZDs) 4. Alpha-Glucosidase Inhibitors 5. D-Phenylalanine Meglitinides 6.
: Opioid Quantity Limits
March 7, 2017 2017-09: Opioid Quantity Limits The Louisiana Department of Health (LDH), in conjunction with the Louisiana Medicaid Drug Utilization Review (DUR) Board, has revised quantity limits for selected
Medications & Mothers Milk 2017
See Monograph for Details Alesse, Aviane, Lessina, Levlite, Lutera, Sronyx Monophasic Ethinyl estradiol 20 mcg Levonorgestrel 0.1 mg Angeliq Monophasic Estradiol 1 mg Drospirenone 0.5 mg Approved in Europe
1/15/2018. Disclosures. Current Diabetes Medications. Objectives NON-INSULIN AGENTS. Diabetes Med Classes. Mealtime
Disclosures Current Diabetes Medications None Claire Baker, M.D. Diabetes & Endocrine Associates January 24, 2018 Objectives Identify categories of diabetes medications Understand the pharmacology of diabetes
Conversion chart from fentanyl to opana er
Conversion chart from fentanyl to opana er (e.g., Nucynta). Both opioid products involved in conversion are one of the following: morphine, oxycodone, oxymorphone, hydromorphone (not extended- release),
Doctor discussion guide:
Bring this printout to your next doctor s appointment. It will help you and your doctor work together to set goals for treatment, evaluate the success of your treatment, and reduce your risk of side effects.
Proposed Changes to Existing Measure for HEDIS : Use of Opioids at High Dosage (UOD)
Proposed Changes to Existing Measure for HEDIS 1 2020: Use of Opioids at High Dosage (UOD) NCQA seeks comments on proposed revisions to the Use of Opioids at High Dosage HEDIS measure. The current measure
CHAMP: Bedside Teaching TREATING PAIN. Stacie Levine MD. What is the approach to treating pain in the aging adult patient?
CHAMP: Bedside Teaching TREATING PAIN Stacie Levine MD Teaching Trigger: An older adult patient is identified as having pain. Clinical Question: What is the approach to treating pain in the aging adult
2013 Quantity Level Limits (QLL) Criteria
Certain drugs covered through your EmblemHealth Medicare PDP Medicare Plan are covered for only a limited quantity. We do this to ensure compliance with the US Food and Drug Administration and manufacturer
ANGIOTENSIN RECEPTOR BLOCKERS
Step Therapy 2014 2 Tier-Alameda Last Updated: 10/10/2014 ANGIOTENSIN RECEPTOR BLOCKERS Benicar Benicar Hct Diovan Valsartan Step 1: First line therapy should be irbesartan, irbesartan/hctz, losartan,
Responsible Quantity Program Effective 4/1/10. Abilify oral solution
Abilify Abilify Discmelt Abilify oral solution Aciphex Actiq Page 1 of 9 750 ml 120 units Actonel 5 mg, 30 mg Actonel 35 mg 4 tabs Actonel 75 mg 2 tabs Actonel 150 mg 1 tab Actonel with Calcium Adcirca
Slide 1. Slide 2. Slide 3. Opioid (Narcotic) Analgesics and Antagonists. Lesson 6.1. Lesson 6.1. Opioid (Narcotic) Analgesics and Antagonists
Slide 1 Opioid (Narcotic) Analgesics and Antagonists Chapter 6 1 Slide 2 Lesson 6.1 Opioid (Narcotic) Analgesics and Antagonists 1. Explain the classification, mechanism of action, and pharmacokinetics
What s New in Diabetes Treatment. Disclosures
What s New in Diabetes Treatment Shiri Levy M.D. Henry Ford Hospital Senior Staff Physician Service Chief, West Bloomfield Hospital Endocrinology, Metabolism, Bone and Mineral Disorders Disclosures None
Doctor discussion guide:
Doctor discussion guide: MAnaging Cholesterol Bring this printout to your next doctor s appointment. It will help you and your doctor work together to set goals for treatment, evaluate the success of your
Long-Acting Opioid Analgesics
Market DC Long-Acting Opioid Analgesics Override(s) Prior Authorization Step Therapy Quantity Limit Approval Duration Initial request: 3 months Maintenance Therapy: Additional prior authorization required
PAIN. TREATMENT TABLES Analgesics. NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose
NON-OPIOID SHORT-ACTING LONG-ACTING **** O PAIN TREATMENT TABLES Analgesics NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose Tramadol 50 mg Ultram Every 4 hours 1-2 tabs,
Long-Acting Opioid Analgesics
Market DC Long-Acting Opioid Analgesics Override(s) Prior Authorization Step Therapy Quantity Limit Approval Duration Initial request: 3 months Maintenance Therapy: Additional prior authorization required
Report Writing Specifications
Report Writing Specifications Adverse Drug Events Primary Measures Anticoagulants, Opioids and Hypoglycemic Agents Washington State Hospital Association 2017 Contents Acknowledgements... 2 Terms Used in
Prescription Drug Abuse: Colorado and Nationwide
Prescription Drug Abuse: Colorado and Nationwide Eric Lavonas, MD Associate Director, Rocky Mountain Poison and Drug Center Associate Professor, University of Colorado School of Medicine 1 What s the Problem?
DIABETES. overview of pharmacologic agents used in the management of. Overview 4/3/2014 OBJECTIVES. Injectable Agents
overview of pharmacologic agents used in the management of DIABETES Kyle Roberts, Pharm.D. PGY-1 Pharmacy Resident Saint Alphonsus RMC 1. List the different classes of diabetes medications, including the
South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina
South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina 29202-8206 Pharmacy and Therapeutics (P&T) Committee Meeting MINUTES 1. Call to Order A meeting of the
Drug Use Evaluation: Short Acting Opioids (SAO)
Drug Use Evaluation: Short Acting Opioids (SAO) Summary Short acting opioid analgesics are one of the most prescribed (top 10) and highest cost (top 20) medication classes for the Oregon Fee For Service
2014 Quantity Limits (QL) Criteria
2014 Quantity Limits (QL) Criteria Certain drugs covered through your EmblemHealth Medicare HMO/PPO Medicare Plan are covered for only a limited quantity. We do this to ensure compliance with the US Food
I. UNIFORM FORMULARY REVIEW PROCESS
DOD PHARMACY AND THERAPEUTICS COMMITTEE RECOMMENDATIONS INFORMATION FOR THE UNIFORM FORMULARY BENEFICIARY ADVISORY PANEL I. UNIFORM FORMULARY REVIEW PROCESS Under 10 United States Code 1074g, as implemented
Diseases & Conditions
http://my.clevelandclinic.org Diseases & Conditions About Cholesterol-Lowering Drugs Some people have a genetic predisposition to high blood cholesterol levels. These people may need drug therapy in addition
Disposal by Flushing of Certain Unused Medicines: What
Disposal by Flushing of Certain Unused Medicines: What You Should Know Drugs Page 1 of 5 Disposal by Flushing of Certain Unused Medicines: What You Should Know Overview Frequently Asked Questions List
AETNA BETTER HEALTH Prior Authorization guideline for Narcotic Analgesic Utilization
AETNA BETTER HEALTH Prior Authorization guideline for Narcotic Analgesic Utilization Policy applies to all formulary and non-formulary schedules II V opioid narcotics, including tramadol and codeine, as
Carefirst. +.V Family of health care plans
Family of health care plans Prior Authorization Form 1361M Opioids ER MME Limit and Post Limit This fax machine is located in a secure location as required by HPAA regulations. Complete/review information,
Opioids: Use, Abuse and Cause of Death. Jennifer Harmon Assistant Director - Forensic Chemistry Orange County Crime Laboratory
Opioids: Use, Abuse and Cause of Death Jennifer Harmon Assistant Director - Forensic Chemistry Orange County Crime Laboratory jharmon@occl.ocgov.com Opioid: Any psychoactive chemical that resembles morphine
Equianalgesic Dosing of Opioids for Pain Management
PL Detail-Document #300405 This PL Detail-Document accompanies the related article published in PHARMACIST S LETTER / PRESCRIBER S LETTER April 2014 Equianalgesic Dosing of Opioids for Pain Management
ABILIFY ABILIFY DISCMELT ACTONEL ACTOPLUS MET ACTOPLUS MET XR ACTOS ADCIRCA ADVAIR DISKUS ADVAIR HFA
Quantity Limits Paramount Medicare Formulary 2012 Formulary ID 12112, Version 22. CMS Approved 10-23-2012. ABILIFY Abilify TABS ABILIFY DISCMELT Abilify Discmelt ACTONEL Actonel TABS 150MG Actonel TABS
Prior Authorization Guideline
Guideline GL-35952 Opioid Quantity Limit Overrides Formulary OptumRx Formulary Note: Approval Date 7/10/2017 Revision Date 7/10/2017 Technician Note: P&T Approval Date: 2/16/2010; P&T Revision Date: 7/12/2011
Non-Statin Lipid-Lowering Agents M Holler - Last updated: 10/2016
Drug/Class Cholestyramine (Questran) Bile acid sequestrant Generic? Lipid Effects Y/N (monotherapy) Y LDL : 9% (4 g to 8 ; 21% (16 g to 20 ; 23% to 28% (>20 HDL : 4% to 8% (16 to 24 TG : 11% to 28% (4
2013 Quantity Level Limits (QLL) Criteria
Certain drugs covered through your EmblemHealth Medicare PDP Medicare Plan are covered for only a limited quantity. We do this to ensure compliance with the US Food and Drug Administration and manufacturer
Objectives. How Medicine Works to Control Blood Sugar Levels. What Happens When We Eat? What is diabetes? High Blood Glucose (Hyperglycemia)
How Medicine Works to Control Blood Sugar Levels Stacie Petersen, RN, CDE Objectives Define Diabetes List how medications work (ominous octet) Identify side effects of medications for diabetes What is
Cigna Drug and Biologic Coverage Policy
Cigna Drug and Biologic Coverage Policy Subject Opioid Therapy Table of Contents Coverage Policy... 1 General Background... 4 Coding/Billing Information... 7 References... 7 Effective Date..1/1/2018 Next
Narcotic Equivalence Converter Narcotic Route Dose Duration; Select a drug: mg Convert to: mg Adapted from Tarascon Pocket Pharmacopoeia.
Narcotic Equivalence Converter Narcotic Route Dose Duration; Select a drug: mg Convert to: mg Adapted from Tarascon Pocket Pharmacopoeia. Created: Monday, March 12. Online calculator to convert equianalgesic
DM Fundamentals Class 4 Meds for Type 2
DM Fundamentals Class 4 Meds for Type 2 Beverly Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Copyright 1999 2015, Diabetes Education Services, All Rights Reserved. Diabetes Meds
Disposal of Unused Medicines: What You Should Know
1 of 8 3/12/16 11:14 PM U.S. Food and Drug Administration Protecting and Promoting Your Health Disposal of Unused Medicines: What You Should Know Topics on this page Overview List of Medicines Recommended
Supplementary Online Content
Supplementary Online Content Berkowitz SA, Krumme AA, Avorn J, et al. Initial choice of oral glucose-lowering medication for diabetes mellitus: a patient-centered comparative effectiveness study. JAMA
Diabetes Treatment Guidelines
Diabetes Treatment Guidelines For more comprehensive information about current approaches to the diagnosis and treatment of diabetes, visit the American Diabetes Association Standards of Medical Care 2018
USE OF OPIODS AT HIGHER DOSES IN PERSONS WITHOUT CANCER: MORPHINE EQUIVALENT DOSE EDIT
BACKGROUND: USE OF OPIODS AT HIGHER DOSES IN PERSONS WITHOUT CANCER: MORPHINE EQUIVALENT DOSE EDIT Approximately 10% of patients who are prescribed opioids and seek care from multiple doctors, are prescribed
Connecticut Medicaid P&T Meeting Minutes June 3, 2010
The meeting started at 6:30 pm Attendance Connecticut Medicaid P&T Meeting Minutes June 3, 2010 Present Members: Carl Sherter, MD Peggy Manning Memoli, Pharm D Eric Einstein, MD Ezra Griffith, MD Manage
Fee-for-Service Pharmacy Provider Notice #216 ** March 2016 PDL Changes ** Existing Drug Classes
Fee-for-Service Pharmacy Provider Notice #216 ** March 2016 PDL Changes ** December 19, 2016 Please be advised that the Department for Medicaid Services (DMS) is making changes to the Kentucky Medicaid
Diabetes Mellitus Type 2
Diabetes Mellitus Type 2 What is it? Diabetes is a common health problem in the U.S. and the world. In diabetes, the body does not use the food it digests well. It is hard for the body to use carbohydrates